Late-life depression: How to treat patients with comorbid chronic illness

In persons age 65 and older, the incidence of depression increases with the degree of physical health problems. Higher levels of mortality among depre ssed patients may be attributed to psychological stress, which triggers the production of cortisol by the adrenal glands and thereby adversely affects the immune system. Some 70 to 90% of late-life depression is undiagnosed; this often occurs if the patient's depressive symptoms could be attributed to other medical problems. Screening for depression can be done in the prim ary care office in about 1 minute. Older patients with mild depression may need no more than a counselor with good listening skills. Moderate to sever e depression may require antidepressant therapy, usually with very low init ial doses. An epidemic of depression that is expected in the next century w ill require physicians to utilize community resources to care for the aging 'baby-boom' generation.